I suggest the expectations of program be congruent with the job security of the individuals assigned the work to be performed and the risk of their dismissal for under performance. This assumes a lot about the supervisors and managers being able to detect K/S/A gaps and fill them with education, training and exercises to ensure the optimal level of competency, proficiency and mastery of human resources are dutifully scheduled to the work breakdown structure that isn't flawed. I believe Health IT endeavors of this scale and scope deserve a soccer field sized hall to literally display the as-is and to-be elements of the Health IT system so humans can walk it from end-to-end (e.g., data flow or control flow). Because there doesn't seem to be a Common Data Model (dictionary, ...) of human beings (11-wk old fetuses to 115-yo veterans) and the concomitant health care services (00s medical/dental/mentalsurgical specialities/disciplines, 000s devices, 10^5 drugs, ...), the task of integrating two or more different models will be arduous at best.

The smart approach is to pull out health care from the DoD and VA and establish an health / health care organization that finally treats human life longitudinally vice episodially (i.e., servicemembers' 4 - 40-yr career, dependent, veteran). A digital human model (DHM) would be instaniated at conception, personal digital health management would be habitual until death, and postmortem disposition would mark the end of one's human modeling, simulation and animation but become the basis for initializaiton and tuning of others. All of the superficial re-organization, re-alignment, etc. in the U.S. health care system would not jeopardize the self-care and health awareness of individuals. There is a significant health literarcy assumption behind this paradigm that I do not reveal here.

So what happens now? I wonder if the people responsible at these departments are held accountable for missing mandated deadlines and goals or whether their lack of compliance isn't held against them? You'd hope they'd be admonished and that something would befall them, career-wise, as it no doubt would in the private sector. At a time when so many healthcare organizations face severe penalties and funding decreases for missing deadlines, it's imperative that government holds its own healthcare organizations to high standards.